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29 Increasing the number of referrals to the hospital palliative care team of patients who are discharged from critical care with a treatment escalation plan ‘not for readmission to critical care’
  1. Julia Bichard and
  2. Nipuna Gunawardena
  1. North Middlesex University Hospital, UK


A significant portion of patients whose intensive treatment is withdrawn or withheld whilst being in the Critical Care Unit (CCU) do not die imminently, rather they can survive up to several days and even weeks. Thus, they are usually discharged to the ward setting where their care is managed by general medical teams and are made ‘Not for readmission to CCU’.

The Specialist Palliative Care Treatment (SPCT) at our hospital noted that this patient group frequently requires intensive palliative care support but referrals to SPCT are only made when patients are imminently dying or not made at all. It was felt that the input of the SPCT at the point of CCU discharge for these patients could improve patients‘ experiences, by prompting reassessment of treatment plans, and promoting the importance of the patient‘s wishes.

An audit for all patients discharged from CCU with the Treatment Escalation Plan (TEP) ‘Not for readmission to CCU’ found that CCU was referring only 14% of patients with this TEP to SPCT, despite the fact that 75% of them died within that admission.

We undertook an education programme of CCU and outreach team and gradually implemented a policy of automatic referral to palliative care of all patients discharged from Critical Care with the TEP ‘Not for readmission to CCU’.

After several PDSA cycles over 6 months a 100% referral rate to SPCT from CCU for this group of patients was achieved. Our next step is to investigate whether or not this is improving patient outcomes.

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